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“The awkward fact with which US policy wrestles is that People flee the world’s Haitis for a combination of motives. All are deserving of some compassion but how much?” Newsweek , Dec. 4 1991. “Give me your tired, your poor, Your huddled masses yearning to breathe free,

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“The awkward fact with which US policy wrestles is that

People flee the world’s Haitis for a combination of motives.

All are deserving of some compassion but how much?”

Newsweek, Dec. 4 1991

“Give me your tired, your poor,

Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore.

Send these, the homeless, tempest-tossed, to me”

Inscribed at base of Statue of Liberty, by Emma Lazarus


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As you know

in the developing world treatable

infectious diseases remain big killers

Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age

0-44 (World Health Organization)


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Now it’s time to look at number 3:

Malaria

Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age

0-44 (World Health Organization)


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That’s right:

300 million new cases per year

making it the most prevalent serious infectious disease!

Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age

0-44 (World Health Organization)



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www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf



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It’s especially hard on kids

75% of the deaths are among African children


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www.uhhg.org/mcrh/resources/video/malariappt.pdf


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What Is malaria?

  • A mosquito-borne infectious disease caused by Protozoan parasites of the genus Plasmodium


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What Is malaria?

  • Transmitted only by Anopheles Mosquitoes

    (>60 species!)

Seattle Biomedical Research Institute


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What Is malaria?

  • The Disease can be Acute or Chronic


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Acute Symptoms

  • Classical features include cyclic symptoms

    • Cold stage: chills and shaking

    • Hot stage: fever, headache, vomiting, seizures in children

    • Sweating stage: weakness

    • Feel well for period of time, then cycle repeats itself

www.uhhg.org/mcrh/resources/video/malariappt.pdf



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www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf



Each disease has a distinct course18 l.jpg
Each disease has a distinct course

“Tertian Malaria”

(P.falciparum, P.ovale and P.vivax)

fever occurs every third day.

“Quartan Malaria”

(P. malariae)

fever occurs every fourth day.

www.uhhg.org/mcrh/resources/video/malariappt.pdf


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Each disease has a distinct course

P.ovale and P.vivax

can cause chronic malaria,

reappearing after months or years

due to latent parasites in liver

www.uhhg.org/mcrh/resources/video/malariappt.pdf


Each disease also has a distinct geographical distribution l.jpg
Each disease also has a distinct geographical distribution

www.uhhg.org/mcrh/resources/video/malariappt.pdf


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Each disease also has a distinct geographical distribution

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


Each disease also has a distinct geographical distribution22 l.jpg
Each disease also has a distinct geographical distribution

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


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Malaria damages the bodyin a number of ways

  • Red blood cell destruction -> anemia

  • Waves of parasites bursting red blood cells

    Lead to classic cycles of fever and chills


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Malaria damages the bodyin a number of ways

  • Changes adhesive properties of infected

    Red blood cells -> blocking blood vessels leading to Tissue hypoxia


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Malaria damages the bodyin a number of ways

  • If this happens in brain it is cerebral malaria

    which is often fatal

    Blocking blood

    vessels can also

    cause kidney failure


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Malaria damages the bodyin a number of ways

In severe cases 20% of patients can die,

even with the best care


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DIAGNOSIS

  • Gold standard: Multiple thick and thin smears


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Malaria is not currently a serious threat in the US

  • 1300 cases in US per year

  • Essentially all “imported”

  • Also transfusion related malaria

www.uhhg.org/mcrh/resources/video/malariappt.pdf


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Although….

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf




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Not that long ago….

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


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It could come back!

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


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Let step back and lookat the parasites that cause malaria


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It was discovered more than 100 years ago

A French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease

Charles Louis Alphonse Laveran

www.uhhg.org/mcrh/resources/video/malariappt.pdf


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1907 years ago Nobel Prize for Physiology

or Medicine!

French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease

Charles Louis Alphonse Laveran

www.uhhg.org/mcrh/resources/video/malariappt.pdf


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So just who years ago

is this

Plasmodium?

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


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It’s not a years ago

bacterium or

virus but a

eukaryote

like us

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


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However, years ago

unlike us

it lives a

solitary life

as a single

cell

www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf



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Let’s go back to the family tree years ago

http://drnelson.utmem.edu/Woods.Hole/slide5.png


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Let’s go back to the family tree years ago

You and me

http://drnelson.utmem.edu/Woods.Hole/slide5.png


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mushrooms years ago

You and me

http://drnelson.utmem.edu/Woods.Hole/slide5.png


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mushrooms years ago

You and me

plants

http://drnelson.utmem.edu/Woods.Hole/slide5.png


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We are family…. years ago

mushrooms

You and me

Plasmodium

plants

http://drnelson.utmem.edu/Woods.Hole/slide5.png


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They are on the same region of years ago

the eukaryote tree as plants

You and me

Plasmodium

plants

http://drnelson.utmem.edu/Woods.Hole/slide5.png


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Consistent with this, years ago

we now know Plasmodium

and its relatives have a

remnant of the chloroplast

called the apicoplast

which may help it digest

heme and other things

it harvests from red blood cells


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Consistent with this, years ago

we now know Plasmodium

and its relatives have a

remnant of the chloroplast

called the apicoplast

which may help it digest

heme and other things

It harvests from red blood cells

We don’t have this sort of organelle

How might we use that fact??!


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Plasmodium and its relatives years ago

also have a specialized

Structure at one end of the cell

Involved in invading other cells


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www. years ago columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf


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Plasmodium’s closer relatives years ago

Include parasites causing

Babesiosis, Toxoplasmosis,

And Cryptosporidiosis


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Plasmodium has a wildly complex life cycle years ago

6

2

5

3

4

1

Purves et al., Life: The Science of Biology, 4th Edition


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And that’s just in the mosquito! years ago

6

2

5

3

4

1

Purves et al., Life: The Science of Biology, 4th Edition


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The wildly complex life cycle continued years ago

7

8

Purves et al., Life: The Science of Biology, 4th Edition


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Had enough yet?? years ago

9

Purves et al., Life: The Science of Biology, 4th Edition


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Now we get to the troublesome stage years ago

Cycles of replication inside red blood cells

Lead to cycles of fever and chills

And aggregated blood cells block blood vessels

10

Purves et al., Life: The Science of Biology, 4th Edition


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We also need to get back to the next mosquito to complete the cycle

11

Purves et al., Life: The Science of Biology, 4th Edition


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Here’s Glaxo- the cycle

SmithKline’s

Cliff Notes

version